de Freminville Jean-Baptiste, Halimi Jean-Michel, Maisons Valentin, Goudot Guillaume, Bisson Arnaud, Angoulvant Denis, Fauchier Laurent
Service de Cardiologie-Médecine Vasculaire, Hôpital Trousseau, Centre Hospitalier Regional Universitaire de Tours, 37044 Tours Cedex 9, France.
Service de Medecine Vasculaire, Hopital Europeen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Cité, 75015 Paris, France.
J Clin Med. 2024 May 28;13(11):3159. doi: 10.3390/jcm13113159.
: Cardiorenal syndrome (CRS) is a disorder of the heart and kidneys, with one type of organ dysfunction affecting the other. The pathophysiology is complex, and its actual description has been questioned. We used clustering analysis to identify clinically relevant phenogroups among patients with CRS. : Data for patients admitted from 1 January 2012 to 31 December 2012 were collected from the French national medico-administrative database. Patients with a diagnosis of heart failure and chronic kidney disease and at least 5 years of follow-up were included. : In total, 13,665 patients were included and four clusters were identified. Cluster 1 could be described as the vascular-diabetes cluster. It comprised 1930 patients (14.1%), among which 60% had diabetes, 94% had coronary artery disease (CAD), and 80% had peripheral artery disease (PAD). Cluster 2 could be described as the vascular cluster. It comprised 2487 patients (18.2%), among which 33% had diabetes, 85% had CAD, and 78% had PAD. Cluster 3 could be described as the metabolic cluster. It comprised 2163 patients (15.8%), among which 87% had diabetes, 67% dyslipidemia, and 62% obesity. Cluster 4 comprised 7085 patients (51.8%) and could be described as the low-vascular cluster. The vascular cluster was the only one associated with a higher risk of cardiovascular death (HR: 1.48 [1.32-1.66]). The metabolic cluster was associated with a higher risk of kidney replacement therapy (HR: 1.33 [1.17-1.51]). : Our study supports a new classification of CRS based on the vascular aspect of pathophysiology differentiating microvascular or macrovascular lesions. These results could have an impact on patients' medical treatment.
心肾综合征（CRS）是一种心脏和肾脏的疾病，一种器官功能障碍会影响另一种器官。其病理生理学很复杂，对它的实际描述也受到了质疑。我们使用聚类分析来识别CRS患者中临床相关的表型组。：从法国国家医疗行政数据库收集了2012年1月1日至2012年12月31日入院患者的数据。纳入诊断为心力衰竭和慢性肾病且至少有5年随访期的患者。：总共纳入了13665名患者，并识别出四个聚类。聚类1可描述为血管 - 糖尿病聚类。它包括1930名患者（14.1%），其中60%患有糖尿病，94%患有冠状动脉疾病（CAD），80%患有外周动脉疾病（PAD）。聚类2可描述为血管聚类。它包括2487名患者（18.2%），其中33%患有糖尿病，85%患有CAD，78%患有PAD。聚类3可描述为代谢聚类。它包括2163名患者（15.8%），其中87%患有糖尿病，67%患有血脂异常，62%患有肥胖症。聚类4包括7085名患者（51.8%），可描述为低血管聚类。血管聚类是唯一与心血管死亡风险较高相关的聚类（风险比：1.48 [1.32 - 1.66]）。代谢聚类与肾脏替代治疗风险较高相关（风险比：1.33 [1.17 - 1.51]）。：我们的研究支持基于病理生理学血管方面区分微血管或大血管病变的CRS新分类。这些结果可能会对患者的医疗产生影响。
